Renal transplant - NYSORA

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Renal transplant

Learning objectives

  • Definition of a renal transplant
  • Management of a living donor during a nephrectomy
  • Management of a renal transplant recipient

Definition and mechanisms

  • A renal transplant is the organ transplant of a kidney into a patient with end-stage kidney disease (ESRD)
  • Classified as deceased-donor (formerly known as cadaveric) or living-donor nephrectomy (LDN)
  • Improves both length and quality of life for patients with end-stage renal disease (ESRD)
  • ESRD is defined as chronic kidney disease (CKD) with a glomerular filtration rate (GFR) <15 mL/min/1.73 m² or where renal replacement therapy is needed
  • Diabetes is the most common cause of ESRD followed by glomerulonephritis, polycystic kidney disease, pyelonephritis, hypertension, and auto-immune disorders
  • Two-year graft survival is > 80% for cadaveric and 90% for living-donor grafts and overall patient survival is > 95%

Signs and symptoms

See chronic kidney disease


Management of the living donor during nephrectomy 

Live kidney donor, NSAIDs, nephrectomy

Postoperative care of the living donor

  • Provide postoperative analgesia via a fentanyl PCA
  • Consider a paravertebral or TAP block to complement analgesia
  • Avoid NSAIDs
  • Apply early mobilization along with breathing exercises and incentive spirometry
  • Consider postoperative complications:

Management of the recipient

Renal transplant recipient evaluation, ABO compatibility, HLA matching, final cross-match

Renal transplant, hyperkalemia, NSAIDs

Perioperative management of a renal transplant patient

Suggested reading

  • Pollard BJ, Kitchen, G. Handbook of Clinical Anaesthesia. Fourth Edition. CRC Press. 2018. 978-1-4987-6289-2.
  • Mayhew D, Ridgway d, Hunter JM. 2016. Update on the intraoperative management of adult cadaveric renal transplantation. BJA education. 16;2:53-57.
  • O’Brien, B., Koertzen, M., 2012. Anaesthesia for living donor renal transplant nephrectomy. Continuing Education in Anaesthesia Critical Care & Pain 12, 317–321.
  • Rabey P. 2001. Anesthesia for renal transplantation. BJA CEPD Reviews. 1;1:24-17.

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